All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
not a doctor
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HYPOTHESIS:
That the inotropic support of dobutamine may serve as
a bridge to the introduction and use of an ACE inhibitor
or nitroglycerin therapy.

METHODS:
We studied the effectiveness of switching inotrope-dependent
patients in end-stage CHF from IV dobutamine to high-dose
ACE inhibitor/nitrates, with one year follow-up.
	Forty-nine dobutamine-dependent patients with an
average EF of 17% were treated with increasing lisinopril
dose of 1.9 mg to 46 mg per day) and isosorbide dinitrate of
7 mg to 229 mg per day.
	Outpatient dobutamine was continued or repeated as
indicated and then tapered when feasible.

RESULTS:
During the follow-up year, 14 of 49 patients required repeat
dobutamine, with home IV treatment for an average of
6.3 months. At one year:

1) heart class improved from 3.6 to 1.9.
2) Yearly hospitalizations fell from 2.7 to 1.2.
3) Average EF rose from 17% to 24%.

At one year, 14 patients who were still dobutamine-dependent
had much more severe symptoms than patients now off the drug.
Transplant or death occurred in 7 of 14 patients who needed
longer-term dobutamine, but in only 5 of 35 patients free of
dobutamine.
	Patients with poor outcome (10 needed transplant and
12 died) continued to be more limited, with heart class of 2.7
versus class 1.7 in patients now off dobutamine. They also had
more hospitalizations (3.6 versus 0.6), and had no improvement
in EF (17% vs 28% for patients now off the drug).

CONCLUSIONS:
Of the patients on dobutamine, 70% were successfully switched
to ACE inhibitor or nitrate therapy, with improved symptoms
and improved EF, and with reduced hospitalizations.
	30% of patients with continued need for dobutamine
had a significantly poorer one-year outcome.

Title: Dobutamine as Bridge to Angiotensin-Converting Enzyme
Inhibitor-Nitrate Therapy in Endstage Heart Failure
Authors: T. Barry Levine, Arlene B. Levine, William G. Elliott,
Barbara Narins, Robert J. Stomel.
Source: Clin. Cardiol. 24, 231-236 (2001)

For reprints, contact:
T. Barry Levine, M.D.
Michigan Institute for Heart Failure & Transplant Care
Botsford General Hospital
28050 Grand River Avenue
Farmington Hills, MI 48336, USA